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General NPI Number Information
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NPI Number | 1568126001
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Entity Type | Individual
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Provider Name | UDUAKOBONG N IKPE PH.D., J.D.
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Gender | Female
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Dates
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Enumeration Date | 10/29/2021
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Last Update Date | 10/29/2021
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Provider Practice Location Address
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Address Line | 5409 MARYLAND WAY STE 202
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City | BRENTWOOD
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State | TN
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Zip | 37027-1084
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Country | US
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Telephone | 305-213-1087
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Fax |
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Provider Business Mailing Address
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Address Line | 5409 MARYLAND WAY STE 202
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City | BRENTWOOD
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State | TN
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Zip | 37027-1084
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Country | US
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Telephone | 305-213-1087
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 2070
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License Number State | KS
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 9728
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1447
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License Number State | LA
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Taxonomy #4
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 3330
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License Number State | TN
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